European Archives Of Oto-rhino-laryngology[JOURNAL]
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200 papers
Disentangling baseline severity and residual disease from BMI effects after adenotonsillectomy.
Li SH, Hong WZ
Eur Arch Otorhinolaryngol · 2026 May · PMID 42087008 · Publisher ↗
Abstract loading — click title to view on PubMed.
Letter to editor about "The possible effect of forceful eye closure and eye opening on nasal valve cross-sectional area during endoscopy.".
Sinanoglu N
Eur Arch Otorhinolaryngol · 2026 May · PMID 42087007 · Publisher ↗
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Characteristics of pediatric olfactory airflow based on computational fluid dynamics analysis.
Nishijima H, Yamamoto T, Yamakawa K … +4 more , Kagoya R, Ogawa K, Ueha R, Kondo K
Eur Arch Otorhinolaryngol · 2026 May · PMID 42087006 · Publisher ↗
PURPOSE: Pediatric olfactory development remains poorly understood, particularly regarding how age-related nasal morphological changes influence olfactory airflow dynamics and odorant transport. This study aimed to chara...
PURPOSE: Pediatric olfactory development remains poorly understood, particularly regarding how age-related nasal morphological changes influence olfactory airflow dynamics and odorant transport. This study aimed to characterize age-dependent variations in olfactory airflow patterns and odorant distribution within the pediatric nasal cavity using computational fluid dynamics (CFD) analysis. METHODS: Three-dimensional nasal cavity models were reconstructed from high-resolution sinus CT scans of 11 pediatric patients (ages 3-18 years) using Mimics Innovation Suite. CFD simulations of inspiratory airflow were performed using OpenFOAM with physiologically scaled, age- and sex-dependent flow rates. Odorant transport was modeled as a dimensionless passive scalar representing an inert, non-reactive tracer gas to analyze concentration dynamics and arrival times at the olfactory mucosa across age groups. RESULTS: The olfactory cleft volume and airflow generally followed an upward trend from early childhood until approximately 15 years of age, with more pronounced enlargement observed in late adolescence (15-18 years). Young children (3-6 years) demonstrated markedly reduced olfactory airflow delivery compared to late adolescents (15-18 years). Odorant transport analysis revealed prolonged arrival times and reduced peak concentrations at the olfactory mucosa in younger subjects, indicating that anatomical immaturity constrains olfactory efficiency in early childhood. CONCLUSION: Age-related nasal morphological development substantially influences olfactory airflow dynamics and odorant transport efficiency in children. These computational findings provide mechanistic insights into pediatric olfactory development and may inform clinical assessment strategies for childhood olfactory disorders.
Beyond structural defect: quality of life impact of nasal septal perforation in adults - a scoping review of validated patient-reported outcome measures.
Alegre Edo B, Yuen-Ato K, Jubes-Monforte S … +4 more , Arango-Cabezas N, Rojas-Lechuga MJ, Bernal-Sprekelsen M, Alobid I
Eur Arch Otorhinolaryngol · 2026 May · PMID 42087005 · Publisher ↗
BACKGROUND: Nasal septal perforation (NSP) is a structural defect of the nasal septum that can lead to significant symptoms and functional impairment. Although airflow dynamics and mucosal disruption have been proposed t...
BACKGROUND: Nasal septal perforation (NSP) is a structural defect of the nasal septum that can lead to significant symptoms and functional impairment. Although airflow dynamics and mucosal disruption have been proposed to explain symptom burden, the impact of NSP on patient quality of life (QoL) has not been systematically synthesized. The aim of this work is to systematically review the literature evaluating QoL outcomes in adults with NSP using validated patient-reported outcome measures. METHODS: This review followed PRISMA-ScR guidelines. Searches were conducted in PubMed and Web of Science without date restrictions (latest update: October 2025). Eligible studies included adults with symptomatic NSP in whom QoL outcomes were reported using validated questionnaires. Two independent reviewers screened studies and extracted data. RESULTS: From 686 records, 33 studies met inclusion criteria involving 1638 patients. Study designs were primarily case series (n=21) and cross-sectional studies (n=7), with sample sizes ranging from 6-202 patients. SNOT-22 scores across studies indicated moderate-to-severe QoL impairment (range 38.6-53.7). NOSE scores ranged from 39.0-80.0, while NOSE-Perf scores ranged from 13.8-26.4. Limited studies reported generic QoL outcomes (SF-36) or NSP-specific tools (SEPEQoL), but all reflected significant functional impact. Aetiology was most commonly postsurgical, and anterior perforations predominated. Studies reporting surgical outcomes consistently suggested substantial postoperative improvements across QoL instruments. DISCUSSION: NSP is associated with clinically meaningful QoL impairment, particularly in rhinologic, sleep and psychological domains. Despite growing interest, evidence remains heterogeneous and limited by variable reporting of perforation characteristics and inconsistent use of QoL instruments. Standardized assessment and dedicated NSP-specific outcome measures are needed. Future research should focus on prospective, multicentred studies evaluating both symptom burden and long-term treatment outcomes.
The hidden cost of precision: ergonomic strain, wellness, and career longevity in otolaryngology.
Hosn OA, Khalil L, Ghadieh J … +3 more , Korban Z, Barazi R, Zaytoun G
Eur Arch Otorhinolaryngol · 2026 May · PMID 42087004 · Publisher ↗
PURPOSE: To describe the ergonomic challenges inherent to otolaryngology-head and neck surgery and to synthesize current evidence on their impact on surgeon wellness, performance, and career sustainability. METHODS: This...
PURPOSE: To describe the ergonomic challenges inherent to otolaryngology-head and neck surgery and to synthesize current evidence on their impact on surgeon wellness, performance, and career sustainability. METHODS: This narrative review integrates published literature addressing ergonomic risk factors across otolaryngology subspecialties, operative modalities, and clinical settings. Key themes include posture-related strain, visualization systems, operating room design, gender-based anthropometric mismatch, and mitigation strategies reported in observational studies, surveys, and ergonomic frameworks. RESULTS: The literature consistently demonstrates a high prevalence of work-related musculoskeletal disorders among otolaryngologists, most commonly affecting the neck, shoulders, and back. Ergonomic burden varies by subspecialty and surgical modality and is driven by sustained cervical flexion, static postures, asymmetric upper-limb loading, visual strain, and noise exposure. Female surgeons experience a disproportionate ergonomic burden related to mismatch between body dimensions and equipment design, resulting in added cognitive and workflow demands. These factors are associated with pain, reduced efficiency, burnout, and, in severe cases, early modification or cessation of operative practice. CONCLUSION: Ergonomic strain in otolaryngology is widespread, cumulative, and modifiable. Incorporating precision ergonomics, individualized operating room configuration, microbreaks, and early ergonomic education into surgical practice and training is essential to preserve surgeon health, optimize performance, and ensure long-term workforce sustainability.
Predictive value of pan-immune-inflammation value and ultrasonographic parameters in cervical lymphadenopathy: development of a novel clinical scoring system.
Aslan M, Algan B
Eur Arch Otorhinolaryngol · 2026 May · PMID 42087003 · Publisher ↗
OBJECTIVE: Accurate preoperative differentiation of cervical lymphadenopathy (LAP) is essential for optimal surgical planning. This study aimed to evaluate the contribution of preoperative pan-immune-inflammation value (...
OBJECTIVE: Accurate preoperative differentiation of cervical lymphadenopathy (LAP) is essential for optimal surgical planning. This study aimed to evaluate the contribution of preoperative pan-immune-inflammation value (PIV), platelet-to-lymphocyte ratio (PLR), demographic characteristics, and ultrasonographic findings in predicting malignant histopathology in patients undergoing excisional biopsy for cervical LAP, and to develop a practical clinical risk score. MATERIALS AND METHODS: This retrospective cohort study was conducted at a tertiary referral center between January 2014 and December 2025. Patients who underwent excisional cervical lymph node biopsy with available preoperative ultrasonography and complete blood count data were included. The primary outcome was malignant versus non-malignant (reactive or granulomatous) histopathology. Candidate predictors included age, sex, neck level, ultrasonographic features (hilum loss, conglomeration, roundness index, and longest diameter), and inflammatory indices (PIV and PLR). Independent predictors were identified using multivariable logistic regression analysis, while discriminatory performance and optimal cut-off values were assessed using receiver operating characteristic (ROC) analyses. RESULTS: Of the 481 patients included, 184 (38.2%) had reactive, 91 (18.9%) granulomatous, and 206 (42.8%) malignant histopathology. Patients with malignancy were older (median age, 51.5 years) and more frequently male (65.5%) (both p < 0.001). Multivariable analysis demonstrated that conglomeration (OR, 6.18), male sex (OR, 3.51), Level V localization (OR, 7.77), increased roundness index (OR, 2.33), age (OR per year, 1.04), and PIV (OR per unit, 1.001) were independently associated with malignancy. Although PIV showed moderate discriminatory ability (AUC, 0.624), it achieved high specificity (83.3%) at a cut-off value > 567.1. A six-variable, points-based clinical scoring system (range, 0-11) effectively stratified malignancy risk (7.4% in the low-risk group and 83.1% in the high-risk group). CONCLUSION: Malignancy risk in cervical lymphadenopathy can be reliably predicted through the combined assessment of demographic characteristics, ultrasonographic patterns, and the Pan-Immune-Inflammation Value. Conglomeration, Level V localization, advanced age, and elevated PIV emerged as the strongest independent predictors of malignancy. However, multicenter external validation is required before the proposed risk score can be implemented in routine clinical practice.
Diagnostic value of the inner ear computed tomography measurements in detecting congenital sensorineural hearing loss: a comparative study.
Doostparast A, Kareshk MS, Doostparast A … +5 more , Ghandhari M, Ahmadi A, Rajati M, Hashemi J, Layegh P
Eur Arch Otorhinolaryngol · 2026 May · PMID 42087002 · Publisher ↗
BACKGROUND: Congenital sensorineural hearing loss (CSNHL) is a very common subtype of pediatric hearing loss disorders. Less severe deformities in CSNHL might not be recognized during a simple visual inspection in comput...
BACKGROUND: Congenital sensorineural hearing loss (CSNHL) is a very common subtype of pediatric hearing loss disorders. Less severe deformities in CSNHL might not be recognized during a simple visual inspection in computed tomography (CT) of the temporal bone. Therefore, the present study aimed to compare the inner ear measurements between CSNHL patients with grossly normal CT appearance and the healthy population. MATERIALS AND METHODS: Children with confirmed CSNHL were enrolled along with a control group of healthy children. Their CT scans of the temporal bone were retrospectively reviewed. Ten inner ear radiologic measurements, including cochlea height (CH) and width (CW), width of cochlear nerve bony canal (WCN), superior and lateral semicircular canals (SSCC and LSCC) bony island widths, posterior semicircular canal (PSCC) inferior limb length, vestibule height (VH) and width (VW), and vestibular aqueduct (VA) width at the midpoint and operculum were compared between the two groups. RESULTS: 62 children (30 CSNHL, 37 females, mean age: 7.1 ± 3.4 years) were included. The intra-observer repeatability was very good to excellent across all parameters (Intraclass correlation coefficient: 0.83-0.96). CH (P ≤ 0.001) and VA midpoint width (P ≤ 0.001) were significantly higher in CSNHL patients than healthy individuals, and WCN (P ≤ 0.001), SSCC bony island width (P ≤ 0.001) and LSCC bony island width (P = 0.01) were significantly lower. There was no statistically significant difference in terms of CW (P = 0.83), PSCC inferior limb length (P = 0.54), VH (P = 0.67), VW (P = 0.83), and VA operculum width (P = 0.15). WCN (ROC-AUC: 0.80, cut-off point = 1.9 mm, sensitivity = 60%, specificity = 84%) and VA midpoint width (ROC-AUC: 0.80, cut-off point = 1 mm, sensitivity = 77%, specificity = 75%) demonstrated the highest diagnostic utility in identifying CSNHL, followed by CH, SSCC and LSCC bony island widths. CONCLUSION: Inner ear radiologic measurements, particularly WCN and VA midpoint width, demonstrate relatively high diagnostic value in identifying CSNHL with subtle malformations on temporal bone CT.
Switching to dupilumab from other biologic therapies in chronic rhinosinusitis with nasal polyps (CRSWNP): a comparison with biologic-naïve patients.
Lucidi D, Seccia V, Mastrapasqua R … +13 more , Dallari V, Alicandri-Ciufelli M, Fernandez IJ, Pipolo C, Fadda G, Garzaro M, Dell'Era V, Carriera L, Puxeddu I, Menzella F, Gambacorta V, Ricci G, De Corso E
Eur Arch Otorhinolaryngol · 2026 May · PMID 42087001 · Publisher ↗
PURPOSE: Data on the impact of previous biologic treatment on the effectiveness of dupilumab in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma are still limited. This study aimed to compare cl...
PURPOSE: Data on the impact of previous biologic treatment on the effectiveness of dupilumab in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma are still limited. This study aimed to compare clinical outcomes of dupilumab in patients previously treated with asthma-targeted biologics who switched to dupilumab due to inadequate disease control, versus biologic-naïve patients. METHODS: This study was designed as a retrospective matched case-control study within the Italian DUPIREAL network, including patients with severe CRSwNP and severe asthma, all treated with dupilumab. Among these, we identified 44 consecutive patients with severe uncontrolled CRSwNP and asthma who initiated dupilumab after asthma-targeted biologics (Group A) and compared them with biologic-naïve CRSwNP and asthma patients receiving dupilumab as their first biologic treatment (Group B, n = 44), matched 1:1 at baseline based on asthma severity (according to GINA classification). Clinical, endoscopic, olfactory, asthma-related, and laboratory parameters were assessed at baseline and during a 24-month follow-up. RESULTS: Baseline clinical characteristics were comparable between groups. Dupilumab treatment led to a marked and sustained improvement in all the analyzed outcomes in both groups without any significant differences in clinical outcomes at any follow-up timepoint. Among patients who switched to dupilumab, those with well-controlled asthma at baseline did not experience any deterioration in asthma control, whereas patients with uncontrolled asthma showed a significant improvement in asthma control during dupilumab therapy. Although blood eosinophil counts increased more frequently in the switching group from 12 months onward, no negative impact on clinical outcomes, safety, or treatment discontinuation was observed, with comparable adverse event rates between groups. CONCLUSIONS: Dupilumab was equally effective in patients with CRSwNP and asthma regardless of previous biologic treatment. Switching from other asthma-targeted biologics did not lead to loss of asthma control, and switchers more frequently developed eosinophilia without an associated increase in adverse events or treatment discontinuation.
Response to letter to the editor re: "Predicting recovery in Bell's palsy: the impact of early rehabilitation and prognostic indicators".
Lucidi D, Dallari V, Fernandez IJ
Eur Arch Otorhinolaryngol · 2026 May · PMID 42087000 · Publisher ↗
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Video head impulse testing before and after canalith repositioning for benign paroxysmal positional vertigo.
Vongviriyangkoon T, Limviriyakul S, Thongyai K … +3 more , Atipas S, Prakairungthong S, Suvarnsit K
Eur Arch Otorhinolaryngol · 2026 May · PMID 42086999 · Publisher ↗
OBJECTIVE: To evaluate video head impulse testing (vHIT) outcomes in patients with benign paroxysmal positional vertigo (BPPV) before canalith repositioning maneuver (CRM), immediately after treatment, and 1 week post-tr...
OBJECTIVE: To evaluate video head impulse testing (vHIT) outcomes in patients with benign paroxysmal positional vertigo (BPPV) before canalith repositioning maneuver (CRM), immediately after treatment, and 1 week post-treatment. STUDY DESIGN: Prospective before-after study. SETTING: Tertiary referral center. PATIENTS: Of 156 patients with vertigo and positional nystagmus, 63 were diagnosed with BPPV using standard maneuvers; 51 had posterior canal BPPV, 11 had lateral canal BPPV and 1 had anterior canal BPPV. All underwent vHIT to assess vestibulo-ocular reflex (VOR) gain across all 6 semicircular canals and completed the Dizziness Handicap Inventory before and after treatment. INTERVENTIONS: CRMs specific to the affected canal. MAIN OUTCOME MEASURES: VOR gain and Dizziness Handicap Inventory scores before and after CRM. RESULTS: At pre-treatment, 59 patients (93.7%) exhibited VOR gains within normative limits. Only four patients (6.3%) showed decreased VOR gains, all of whom were diagnosed with posterior canal BPPV. VOR gain did not differ significantly across pre-treatment, immediate post-treatment, and 1-week assessments. No corrective saccades were detected. CONCLUSIONS: vHIT showed no significant post-treatment changes and may have limited incremental value in the routine evaluation of isolated BPPV cases.
Subclinical auditory effects of recreational diving: a multidimensional audiological assessment beyond the audiogram.
Kartal Özcan A, Yazar B, Özer Ş … +3 more , Dutak F, Aytaç K, Yılmaz Şahin AA
Eur Arch Otorhinolaryngol · 2026 May · PMID 42086998 · Publisher ↗
PURPOSE: This study aimed to evaluate peripheral auditory function and Eustachian tube function in individuals engaged in recreational diving compared with non-diving controls, via a multidimensional audiological assessm...
PURPOSE: This study aimed to evaluate peripheral auditory function and Eustachian tube function in individuals engaged in recreational diving compared with non-diving controls, via a multidimensional audiological assessment approach. METHODS: A total of 49 participants aged 18-50 years were included, comprising 24 individuals actively engaged in scuba or free diving who reported no auditory or neurotological complaints prior to initiating diving, and 25 non-diving controls without any otologic or neurologic disorders. All participants underwent otorhinolaryngologic examination, conventional and wideband tympanometry, Eustachian tube function (ETF) testing, pure-tone audiometry, and distortion product otoacoustic emission (DPOAE) measurements. The subjective ETF was assessed via the Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7). RESULTS: Pure-tone audiometry, speech audiometry, and conventional tympanometric measurements were not significantly different between the groups (all p > 0.05). In the diver group, the middle ear resonance frequency was significantly lower in at least one ear than in the control group (p < 0.05). Objective ETF testing revealed a higher frequency of Eustachian tube dysfunction in diver group (p < 0.05), and ETDQ-7 scores were also significantly higher in this group (p < 0.05). Additionally, DPOAE measurements revealed significant group differences at higher frequencies, with reduced amplitudes observed in divers (p < 0.05). CONCLUSION: Recreational diving may be associated with subclinical alterations in middle ear mechanics, Eustachian tube function, and cochlear outer hair cell activity that are not detected by standard audiometric evaluations. The inclusion of wideband tympanometry, objective ETF testing, and high-frequency DPOAE measurements may provide complementary information for audiological evaluation of individuals engaged in recreational diving.
Association between remnant cholesterol and short-term hearing outcomes in sudden sensorineural hearing loss.
Li Q, Lai H, Ma L … +3 more , Yin J, Wu J, Yang H
Eur Arch Otorhinolaryngol · 2026 May · PMID 42086997 · Publisher ↗
PURPOSE: Dyslipidemia has been implicated in the pathogenesis and prognosis of sudden sensorineural hearing loss (SSNHL). Remnant cholesterol (RC), a novel lipid parameter, predicts cardiovascular outcomes independently...
PURPOSE: Dyslipidemia has been implicated in the pathogenesis and prognosis of sudden sensorineural hearing loss (SSNHL). Remnant cholesterol (RC), a novel lipid parameter, predicts cardiovascular outcomes independently of traditional lipid indices, but its prognostic value in SSNHL remains unclear. We examined whether baseline RC is associated with short-term hearing outcome after systemic treatment. METHODS: We conducted a retrospective cohort study of 399 patients diagnosed with SSNHL who received standardized systemic treatment for 1-2 weeks. RC was calculated as total cholesterol - LDL-C - HDL-C. The primary endpoint was non-recovery, defined as a pure-tone average (PTA) improvement < 15 dB; sensitivity analyses used < 10 dB based on different guidelines. Multivariable logistic regression and restricted cubic spline analyses were used to evaluate associations. Patients were additionally stratified by LDL-C and RC to assess prognostic information beyond LDL-C. RESULTS: Of the 399 patients, 178 (44.6%) achieved short-term hearing recovery. Higher RC was independently associated with non-recovery (adjusted OR 2.25, 95% CI 1.34-3.77; P = 0.002), and spline analyses suggested an approximately linear relationship. Findings were consistent using the 10 dB definition (adjusted OR 2.10, 95% CI 1.31-3.36; P = 0.002). Compared with low LDL-C/low RC, non-recovery odds were higher in high LDL-C/low RC (adjusted OR 1.85, 95% CI 1.17-2.95), low LDL-C/high RC (adjusted OR 3.52, 95% CI 1.37-9.06), and high LDL-C/high RC (adjusted OR 2.06, 95% CI 1.63-4.41). CONCLUSIONS: Elevated RC is independently associated with poorer short-term recovery in SSNHL. RC may serve as an easily obtainable biomarker for short-term recovery stratification in SSNHL.
Neural response patterns in inner ear malformations: a scoping review of eABR findings.
Kadihanoglu S, Yarali M
Eur Arch Otorhinolaryngol · 2026 May · PMID 42086996 · Publisher ↗
PURPOSE: This scoping review aimed to synthesize current evidence on electrically evoked auditory brainstem responses (eABRs) in individuals with inner ear malformations (IEMs), with a focus on extraction rates, waveform...
PURPOSE: This scoping review aimed to synthesize current evidence on electrically evoked auditory brainstem responses (eABRs) in individuals with inner ear malformations (IEMs), with a focus on extraction rates, waveform characteristics, and clinical implications. METHODS: Following PRISMA-ScR and JBI guidelines, a systematic search was conducted in CINAHL, MEDLINE, EMBASE, and PubMed for studies published between January 2005 and June 2025. We included original research articles reporting eABR findings in participants with IEMs. Twenty-one studies met the eligibility criteria. RESULTS: eABRs were generally obtainable in children with IEMs, though higher thresholds and lower response detectability were frequently observed compared to peers with normal cochlear anatomy. Certain subtypes, such as common cavity and cochlear nerve canal stenosis, often exhibited elevated thresholds. Despite this, wave latency parameters often remained stable. Among patients with Incomplete Partition Type II (IP-II), eABR detectability varied considerably, indicating that cochlear size alone does not determine neural response strength. Factors such as stimulation site, electrode type, and timing of auditory input influenced eABR outcomes. CONCLUSION: eABR is a useful tool for evaluating auditory pathway integrity in patients with IEMs. Elevated thresholds may reflect reduced neural synchrony, yet stable waveforms suggest retained function. Incorporating both anatomical and functional data may improve clinical interpretation and decision-making.
Surgical decision-making in cholesteatoma-induced labyrinthine fistula: hearing outcomes in a tertiary referral center.
Akyıldız İ, Günay M, Tokgöz SA … +3 more , Mutlu M, Özlügedik S, Dağlı M
Eur Arch Otorhinolaryngol · 2026 May · PMID 42086995 · Publisher ↗
OBJECTIVE: To evaluate surgical outcomes in patients with cholesteatoma-induced labyrinthine fistula, with particular emphasis on hearing preservation across different fistula stages and in selected cases requiring parti...
OBJECTIVE: To evaluate surgical outcomes in patients with cholesteatoma-induced labyrinthine fistula, with particular emphasis on hearing preservation across different fistula stages and in selected cases requiring partial labyrinthectomy. METHODS: A retrospective analysis was conducted on patients who underwent surgery for cholesteatoma with intraoperatively confirmed labyrinthine fistula at a tertiary referral center. Demographic data, clinical findings, radiological characteristics, fistula localization, size, and stage were recorded. Fistulae were classified according to the Dornhoffer-Milewski system. Surgical management was individualized according to fistula stage and intraoperative findings. Preoperative and 6-month postoperative bone-conduction (BC) thresholds were compared to assess audiological outcomes. Fistula size was measured on preoperative high-resolution computed tomography, and its relationship with postoperative hearing outcomes was analyzed. RESULTS: Among 230 patients operated on for cholesteatoma, 39 (17.0%) had a labyrinthine fistula. The lateral semicircular canal was the most frequently involved site (84.6%). According to fistula stage, 17.9% were grade I, 53.8% grade II, and 28.2% grade III. Overall, mean BC thresholds showed no statistically significant change at 6 months postoperatively (p = 0.176). Hearing outcomes remained stable in grade I and grade II fistulae, whereas grade III fistulae demonstrated heterogeneous audiological outcomes, with a trend toward postoperative deterioration overall and slight improvement in selected patients managed without partial labyrinthectomy, without reaching statistical significance. Partial labyrinthectomy was performed in five patients with extensive grade III fistulae; although postoperative BC thresholds increased, residual hearing was preserved in all cases and no patient progressed to complete anacusis. Transient postoperative vestibular symptoms resolved with conservative management, and no patient developed persistent disabling vertigo. CONCLUSION: Surgical management of cholesteatoma-induced labyrinthine fistula enables effective disease control with acceptable functional outcomes. Hearing preservation is generally achievable in early-stage fistulae, and even in selected advanced cases requiring partial labyrinthectomy, the applied surgical approach may allow preservation of residual hearing. These findings support an individualized, experience-based surgical approach guided by fistula characteristics and intraoperative assessment rather than fistula stage alone.
Potential roles of microRNAs in chronic rhinosinusitis: from mechanistic insights to clinical studies.
Pasupat D, Chaiyasate S, Thonusin C … +2 more , Chattipakorn N, Chattipakorn SC
Eur Arch Otorhinolaryngol · 2026 May · PMID 42086994 · Publisher ↗
BACKGROUND: Chronic rhinosinusitis (CRS) is a complex disorder influenced by both environmental and genetic factors. Due to incomplete understanding of its pathophysiology, effective treatment remains challenging. Micror...
BACKGROUND: Chronic rhinosinusitis (CRS) is a complex disorder influenced by both environmental and genetic factors. Due to incomplete understanding of its pathophysiology, effective treatment remains challenging. Microribonucleic acids (miRNAs) have emerged as one of the promising epigenetic regulators, with increasing evidence supporting their role in modulating multiple diseases. This insight might inform future research directions toward the development of miRNA-based biomarkers and therapies. OBJECTIVE: This comprehensive scoping review summarizes the current literature on the functions of miRNAs as epigenetic regulators in CRS. METHODS: A comprehensive literature review from PubMed database, focusing on chronic rhinosinusitis/nasal polyps and microRNA/miRNA. RESULTS: Numerous clinical, in vivo, and in vitro studies have identified altered miRNA levels in CRS, and distinct profiles between type 2 and non-type 2 endotypes of CRS. Several studies revealed positive correlations between miRNAs and symptom scores, objective disease measurements, and polyp recurrence. Certain in vivo and in vitro studies also demonstrated the effects of miRNAs changes mainly on inflammation and tissue remodeling, such as epithelial-mesenchymal transition, or fibrin deposition in nasal polyps. The most researched miRNAs in which involved these mechanisms include miR-125b, miR-155, miR-21, and miR-145-5p. miRNAs also have been shown to contribute to other CRS-related processes, including increased mucus secretion and vascular permeability. Collectively, these findings support the effects of miRNA on CRS development. However, a few studies indicated contradictory results, suggesting that miR-21 has a role in anti-inflammation. CONCLUSION: Increasing evidence highlights the role of miRNAs in CRS pathogenesis. Further research on miRNA-based biomarkers and therapies is warranted.
Prestin as a potential biomarker for cochlear injury: Current evidence and future directions.
Streefkerk N, Timmer R, Larsson AIE … +6 more , de Jager KE, Hoetink AE, Vermeij WP, Huitema ADR, van Grotel M, van den Heuvel-Eibrink MM
Eur Arch Otorhinolaryngol · 2026 May · PMID 42086993 · Publisher ↗
PURPOSE: Prestin has been identified as a potential biomarker for cochlear damage and consequent ototoxicity. Although several preclinical and clinical studies have investigated prestin, a comprehensive overview of the e...
PURPOSE: Prestin has been identified as a potential biomarker for cochlear damage and consequent ototoxicity. Although several preclinical and clinical studies have investigated prestin, a comprehensive overview of the evidence regarding its diagnostic value across different types of auditory damage and its use for cancer treatment-related ototoxicity is currently lacking. METHODS: A structured literature review, based on a systematic PubMed search, was conducted to summarize preclinical and clinical studies that evaluated serum and/or plasma prestin levels in association with cochlear damage. Studies were categorized by etiology, moment of biomarker assessment, and correlation with functional hearing outcomes. RESULTS: Twenty-one studies (six animal, 15 human) were included. In animal models, prestin levels increased within hours to days after cochlear injury. Clinical studies showed elevated prestin levels within 30 days after acute damage, due to cisplatin exposure, noise exposure, or surgery. Higher prestin levels correlated with elevated hearing thresholds in six studies, whereas findings were more variable in age-related or chronic hearing loss. So far, no pediatric populations have been studied, and reference values or diagnostic thresholds for prestin are lacking. CONCLUSION: Prestin shows potential for use as a biomarker for acute cochlear damage, with time-dependent patterns observed in both animal and human studies. However, heterogeneity in study design, patient populations, and measurement methods limits current general conclusions and recommendations for its use in the clinical field. Further standardized and longitudinal studies, including pediatric and cancer-survivor cohorts, are needed to determine its clinical utility.
Menière's disease clinical subtypes and baseline characteristics in a Dutch patient cohort.
Boreel MME, Verhoeven HS, van Esch BF … +3 more , Schermer TR, van Benthem PPG, Bruintjes TD
Eur Arch Otorhinolaryngol · 2026 May · PMID 42086992 · Publisher ↗
PURPOSE: The aim of this study is to provide a detailed description of a Dutch cohort of patients with Menière's disease (MD), classify patients into clinical subtypes according to the criteria proposed by Frejo et al.,...
PURPOSE: The aim of this study is to provide a detailed description of a Dutch cohort of patients with Menière's disease (MD), classify patients into clinical subtypes according to the criteria proposed by Frejo et al., and compare the distribution of these subtypes with cohorts from Spain, the United States, and China. METHODS: A retrospective, cross-sectional chart review was conducted among 375 patients diagnosed with definite MD at two Dutch medical centers. Patients were classified into five clinical subtypes of unilateral MD or 5 subtypes of bilateral MD. Baseline characteristics were analyzed and compared across subtypes and international cohorts. RESULTS: Of the 375 included patients, 335 had unilateral MD of which 49.0% were type 1 (classic MD), 23.6% type 2 (delayed MD), 6.6% type 3 (familial MD), 13.7% type 4 (migraine-associated MD), and 7.2% type 5 (autoimmune MD). This distribution differed significantly from the Spanish cohort regarding the delayed and familial subgroups, and from the Chinese cohort regarding the familial subgroup. Forty cases of bilateral MD were observed, with differences in the synchronic subgroup when compared to the Spanish cohort. CONCLUSION: This study describes the clinical subtypes of MD within a Dutch patient cohort, with subtype distributions more closely resembling those of the American and Chinese cohorts than the Spanish cohort. This suggest regional variation in the clinical expression of MD.
Hennebert's sign due to intralabyrinthine schwannoma - case report.
van de Berg R, van Orsouw M, Szweryn WJ … +4 more , Waterval JJ, Postma AA, Kunst HPM, Stultiens JJA
Eur Arch Otorhinolaryngol · 2026 May · PMID 42086991 · Publisher ↗
OBJECTIVE: To illustrate how careful examination can reveal signs that may be elicited by an intralabyrinthine schwannoma. PATIENTS: A patient referred to a tertiary dizziness referral clinic. INTERVENTION(S): The patien...
OBJECTIVE: To illustrate how careful examination can reveal signs that may be elicited by an intralabyrinthine schwannoma. PATIENTS: A patient referred to a tertiary dizziness referral clinic. INTERVENTION(S): The patient underwent extensive vestibular assessment, audiometry, and imaging, including computed tomography (CT) and contrast-enhanced magnetic resonance imaging (MRI). MAIN OUTCOME MEASURE(S): Signs of central or vestibular pathology were assessed, including the fistula test, as well as audiometric thresholds and imaging abnormalities. RESULTS: The patient exhibited unilateral vestibular hypofunction and profound hearing loss in the left ear. Application of a Politzer balloon to the left external auditory canal induced a combination of upbeat nystagmus and horizontal nystagmus to the left, particularly upon pressure release. The CT scan showed no abnormalities. MRI revealed a schwannoma located in the basal and middle turns of the left cochlea extending into the vestibule and in close contact with the stapes. CONCLUSIONS: This case report provides unique evidence of Hennebert’s sign in a patient with an intralabyrinthine schwannoma, highlighting the importance of performing detailed vestibular testing and considering this diagnosis.
The modified apron (Akil) incision: a technical modification to prevent subcutaneous emphysema in partial vertical and supracricoid laryngectomy.
Akıl F, Çelik A
Eur Arch Otorhinolaryngol · 2026 May · PMID 42086990 · Publisher ↗
OBJECTIVE: To describe a modified apron (Akil) incision technique designed to prevent postoperative subcutaneous emphysema in patients undergoing open partial laryngectomy by maintaining an anatomical barrier between the...
OBJECTIVE: To describe a modified apron (Akil) incision technique designed to prevent postoperative subcutaneous emphysema in patients undergoing open partial laryngectomy by maintaining an anatomical barrier between the laryngectomy field and the tracheostomy site. METHODS: This study presents a technical modification applied in patients undergoing open partial laryngectomy, including supracricoid partial laryngectomy and partial verticallaryngectomy. The incision begins bilaterally at the mastoid tips, extends inferiorly along the anterior border of the sternocleidomastoid muscle, and terminatesapproximately 2 cm above the sternal notch. Unlike the conventional apron incision, an intact full-thickness skin bridge (approximately 2-2.5 cm in height) is preservedwithout undermining. All laryngeal framework procedures are performed superior to this bridge, while the tracheostomy is created inferiorly, preventing directcommunication between the two surgical fields. RESULTS: A total of 23 patients were included. None developed clinically significant subcutaneous emphysema requiring intervention. Minor complications included one wound infection, one seroma managed with drainage and compression, and one case of partial wound dehiscence requiring revision. No complications were directly attributable to the incision design. CONCLUSION: The modified Akil incision provides a simple and effective anatomical barrier that may reduce the risk of postoperative subcutaneous emphysema following open partial laryngectomy. This technique is easily reproducible and may improve postoperative outcomes without increasing complication rates.
Long-term economic and welfare consequences of Ménière's disease: a Danish nationwide matched cohort study, 2002-2016.
Grønlund C, Möller S, Christensen HC … +4 more , Andersen MP, Torp-Pedersen C, Devantier L, Djurhuus BD
Eur Arch Otorhinolaryngol · 2026 May · PMID 42086989 · Publisher ↗
PURPOSE: To assess the long-term economic and welfare burden of Ménière's disease, focusing on healthcare costs, income, and reliance on social benefits before and after the first hospital-recorded diagnosis. METHODS: We...
PURPOSE: To assess the long-term economic and welfare burden of Ménière's disease, focusing on healthcare costs, income, and reliance on social benefits before and after the first hospital-recorded diagnosis. METHODS: We conducted a nationwide matched cohort study in Denmark, involving 5,434 patients with a hospital-recorded Ménière's disease diagnosis later confirmed by an otorhinolaryngologist and 16,302 matched controls based on age, sex, civil status, municipality, and index year defined by the first hospital registration of Ménière's disease. The mean age was 59 years, and 56% were females. The study assessed outcomes such as annual healthcare costs, income disparities, and social benefit receipt from ten years prior to ten years after diagnosis. RESULTS: Annual healthcare costs were higher in patients with Ménière's disease after diagnosis, peaking at index year (EUR 3,818 vs. EUR 1,862 in controls). Patients with Ménière's disease also showed a sustained decline in annual income, with the largest decline at year 8 after diagnosis (EUR - 1.908 compared to controls). At index year, 11% of patients transitioned to sickness benefits (vs. 3% of controls). From index year to 120 months post-diagnosis, disability pension rates increased from 10% to 18% in patients with Ménière's disease, whereas they remained almost stable going from 10% to 9% among controls. Similarly, participation in the flexible job scheme rose from 4% to 10% in Ménière's disease compared with 2% to 4% in controls. CONCLUSION: Ménière's disease was associated with persistently higher healthcare costs, reduced income, and greater reliance on social benefits compared with matched controls, particularly evident around and after the time of diagnosis. These findings highlight the substantial long-term economic and welfare burden of the disease.
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